HHVBP (Home Health Value-Based Purchasing)

Every Medicare-certified home health agency competes within a cohort based on beneficiary volume, so smaller agencies are compared against similarly sized peers. CMS scores each agency on a defined measure set, awarding points per measure for either achievement against national standards or improvement over the agency's own baseline, whichever is higher. Those points roll up into a Total Performance Score (TPS), which determines the payment adjustment. Performance lags payment by two years: CY2024 performance drives CY2026 payment adjustments, and CY2026 performance drives CY2028 adjustments. The adjustment applies to every Medicare fee-for-service home health payment the agency receives during the payment year.

CMS rebalanced the measure set for the CY2026 performance year into three weighted categories:

• OASIS-based measures: 40% of the TPS, including new bathing and dressing function measures
• Claims-based measures: 40%, including the new Medicare Spending Per Beneficiary Post-Acute Care (MSPB-PAC) measure alongside hospitalization and discharge-to-community measures
• HHCAHPS survey measures: 20%, with only two measures remaining, Overall Rating of Care and Willingness to Recommend, weighted 10% each

The practical takeaway: OASIS documentation accuracy and claims-driven utilization outcomes now carry 80% of the score, and cost efficiency enters the model through MSPB-PAC for the first time.

The adjustment range is wide relative to typical agency margins. An agency with $5 million in annual Medicare fee-for-service revenue faces up to a $250,000 upside or downside, a half-million-dollar spread between top and bottom performers. That swing lands on top of baseline rate pressure: the CY2026 home health final rule cut aggregate Medicare payments an estimated 1.3%. For many agencies, HHVBP performance is now the difference between a sustainable Medicare book and a losing one. Because of the two-year lag, an agency that waits until it sees a penalty to react is already locked into two more performance years of results.

High performers treat HHVBP as an operating system, not a report to review annually:

• Audit OASIS accuracy at start of care, resumption of care, and discharge, since inaccurate baselines suppress measured improvement
• Target avoidable hospitalizations and observation stays with risk stratification and front-loaded visits
• Work HHCAHPS drivers such as communication and care coordination, since only two survey measures now carry the full 20%
• Review Interim Performance Reports in iQIES quarterly and assign owners to each measure
• Fold measure-level goals into the agency's QAPI program